高分辨CT联合血清CEA、NSE在鉴别诊断良恶性孤立性肺结节中的应用价值

Application Value of High Resolution CT Combined with Serum CEA and NSE in Differential Diagnosis of Benign and Malignant SPN

目的探讨高分辨CT(HRCT)联合血清癌胚抗原(CEA)、神经元特异性烯纯化酶(NSE)在鉴别诊断良恶性孤立性肺结节(SPN)中的应用价值。方法回顾性分析2017年10月~2018年10月于我院就诊发现肺结节的60患者的病例资料,根据术后病理结果分为良性组(n=19)和恶性组(n=41)。两组患者均行HRCT检查及血清CEA、NSE水平检测,并以SPN为状态变量绘制受试者工作特征曲线(ROC曲线)分析HRCT征象及血清CEA、NSE鉴别诊断SPN的诊断效能。结果恶性组分叶征、毛刺征发生率显著高于良性组,差异有统计学意义(P<0.05);恶性组血清CEA、NSE水平显著高于良性组,差异有统计学意义(P<0.05);经ROC曲线分析,HRCT分叶征、毛刺征征象联合血清CEA、NSE鉴别诊断SPN的ROC曲线下面积(AUC)最大(AUC值=0.896),诊断敏感度及特异度分别为82.90%、89.50%。结论肺癌患者HRCT征象多表现为分叶征及毛刺征,且血清CEA、NSE水平异常升高,HRCT联合血清CEA、NSE检测对良恶性SPN的鉴别诊断有一定价值。

Objective To investigate the application value of high resolution computed tomography(HRCT) combined with serum carcinoembryonic antigen(CEA) and neuron-specific enolase(NSE) in the differential diagnosis of benign and malignant solitary pulmonary nodules(SPN). Methods The data of 60 patients with pulmonary nodules who were diagnosed in the hospital from October 2017 to October 2018 were analyzed retrospectively. According to the postoperative pathological results, they were divided into benign group(n=19) and malignant group(n=41). HRCT examination and serum CEA and NSE levels detection were performed in both groups. The receiver operating characteristic curve(ROC curve) was drawn with SPN as state variable to analyze the diagnostic efficiency HRCT signs, serum CEA and NSE for differential diagnosis of SPN. Results The incidence of lobulation and spiculation of malignant group was significantly higher than that of benign group(P<0.05). The levels of serum CEA and NSE in malignant group were significantly higher than those in benign group(P<0.05). By ROC curve analysis, the area under the ROC curve(AUC) of lobulation and spiculation of HRCT combined with serum CEA and NSE was the largest(AUC value = 0.896) for differential diagnosis of SPN. The diagnostic sensitivity and specificity were 82.90% and 89.50%, respectively. Conclusion The HRCT signs of lung cancer patients are mostly lobulation and spiculation, and serum CEA and NSE levels were abnormally elevated. HRCT combined with serum CEA and NSE detection has certain value in the differential diagnosis of benign and malignant SPN.